1. Summary Of The Invention
This invention relates to a medical apparatus and methods for treating sliding hiatal hernias and, more particularly, to the treatment of an upwardly sliding stomach and esophagus to above the diaphragm with a laparoscopic approach and an associated inflatable, torus-shaped prosthesis.
2. Summary Of The Background Art
Gastroesophageal reflux is a significant problem for a large number of the population. The main cause of this is a sliding hiatal hernia. There are two types of hiatal hernia, a sliding and a paraesophageal. By far the majority, approximately 95%, of hiatal hernias are of the sliding variety. A sliding hiatal hernia occurs where the gastroesophageal junction and a proximal portion of the stomach displaces superiorly in to the mediastinum. The esophagus and the stomach slide into an opening of the diaphragm. The other type of hiatal hernia is a paraesophageal hiatal hernia where the gastroesophageal junction remains in its normal position but the main body or fundus of the stomach herniates through the hiatus to the left of the esophagus. With time, increasing amounts of the stomach move into the chest. This represents a life threatening situation and needs to be operated upon.
The sliding type of hiatal hernia often results in gastroesophageal reflux and reflux esophagitis. While this defect is present in a large portion of the general population, actual reflux esophagitis or discomfort is less common. Obesity, increasing weakness of the fascial attachments, chronic coughing, among others lead to this. A number of pharmaceutical agents can increase the risk of reflux.
The symptoms of sliding hiatal hernia are not caused by the hiatal hernia per se but are from the reflux that is present. Normally reflux is prevented by mechanical effects of a segment of the lower esophagus which remains intra abdominal and the lower esophageal sphincter. With increasing abdominal pressure, pressure is transmitted to the distal esophagus and thus reflux is prevented in the normal situation. When the sphincter is incompetent or the distal esophagus is not intraabdominal then reflux can occur. The long-term effects of gastroesophageal reflux is reflux esophagitis with esophogeal stricture and the possibility of carinoma of the esophagus. In addition with severe reflux multiple aspiration pneumonias are possible and even death.
Medical treatment is directed at weight loss, antacids and other anti reflux medications. Very often these are inadequate to alleviate the symptomology. The surgical treatment in the past has required a large abdominal or thoracic incision to correct the problem. Three common proceedures are a Hill gastopexi, a Nissen fundoplication and a Belsi Mark IV fundic wrap. Each of these basically accomplishes a restoration of a segment of intraabdominal esophagus generally four centimeters in length and also provides some means of securing the gastroesophageal junction in an appropriate position to prevent reflux. Another procedure which has been found to be effective is the placement of a prosthesis about the esophagus to maintain an intraabdominal segment. This prosthesis is called an Angelchik prosthesis manufactured by Mentor Corporation of Goleta, Calif. This procedure is a less invasive procedure, does require a large intraabdominal incision but requires less in the way of dissection about the esophagus.
Although common, the standard operational procedures for repair ofsliding hiatal hernias is undesireable, lengthy, and consequently costly. Such procedures also require a large incision with excessive dissection of normal tissue, cause excessive pain and discomfort to the patient, involve unacceptably long recovery and work disability time.
Accordingly, it is an object of the present invention to provide methods and apparatus for the repair of sliding hiatal hernias through laparoscopic techniques comprising a tubular sleeve; a conically shaped guide with an essentially pointed forward end positionable within the sleeve; a prosthesis coupled to the guide; and means for securing the prosthesis around the esophagus of a patient immediately beneath the patient's diaphragm whereby the prosthesis assumes a generally torus shape wherein the prosthesis may be pre-inflated or inflatable and wherein the sleeve is axially splitable after the initiation of insertion of the guide or wherein the prosthesis may be inflatable and further including a hose to inflate the prosthesis after positioning.
It is the further object of the present invention to employ laparoscopic techniques for the repair of sliding hiatal hernias.
It is a further object of the invention to reduce the length of the incision, along with the unnecessary disection of normal tissue, for the repair of sliding hiatal hernias.
It is a further object of the present invention to minimize the time and cost of sliding hiatal hernia operations along with the patient's pain, discomfort and recovery time associated therewith.
It is the further object of the present invention to abate sliding hiatal hernias.
It is a further object of the invention to utilize a sleeve to introduce an inflatable prosthesis for the repair of sliding hiatal hernias.
It is a further object of the invention to utilize an axially splitable sleeve to introduce a pre-filled or inflatable or other prosthesis for the repair of sliding hiatal hernias and other intraabdominal procedures.
The foregoing has outlined some of the more pertinent objects of the invention. These objects should be construed to be merely illustrative of some of the more prominent features and applications of the intended invention. Many other beneficial results can be attained by applying the disclosed invention in a different manner or by modifying the invention within the scope of the disclosure. Other objects and a fuller understanding of the invention may be had by referring to the summary of the invention and the detailed description of the preferred embodiments in addition to the scope of the invention defined by the claims taken in conjunction with the accompanying drawings.